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018-2011-86-000
Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 592289 (ATTACH TO PERMIT) GENERAL INFORMATION State Plan ID No: Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)] 2928368 Permit Holder's Name: T City Village Township Parcel Tax No: RICK HUARD TOWN OF HAMMOND 018-2011-86-000 CST BM Elev: Insp. BM Elev: BM Description: Section/Town/Range/Map No: 9(, 6 _ 3 G5'r 30.29.17.1101 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. at Septic Benchmark Dosing Alt. BM Aeration Bldg. Sewer pG , q Holdin St/Ht Inlet TANK SETBACK INFORMATION St/Ht Outlet TANK TO P/ WELL BLDG. (29 Air Air Intake ROAD Dt Inlet Septic / Q ✓ Dt /V / Dosing Header/Man. c~Q Aeration Dist. Pipe L p ` / Holding Bot. System 7 7 G ` 7 Z PUMP/SIPHON INFORMATION Final Grade 3.5 717-(0 Manufacturer ` ~Ll+ ` 1 GPM Demand St Covra{ Model Number /5AJ k.7 TDH LiftIJ Friction Loss System Head / TDH/3 Ft Forcemain 1 5C Length / Dia.Z is Dist. to Well /,C)ds j SOIL ABSORPTION SYSTEM 4A4 ',jjPf BED/TRENCH Width Length No. 0 hes PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS 14 9,6 r e SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer: UN OR INFORMATION Type W em UNIT Model Number IT Model Number: ystem: zz'l 3(o'l CHAMBER SYf1S' o►I~+~J~" DISTRIBUTION SYSTEM Header/Manifold IDst'ibution i s 7t~J Ix Hole Size x Hole Spacing ) 1VPto Airr IIntake r ! Length Dia LDia Spacing W 17F., SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only ' Depth Over Depth Over 1XX Depth of xx Seeded/Sodded xx Mulched 17, 1 N11-1., Bed/Trench Center Bed/Trench Edges Topsoil Yes E No Yes F_ No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: Q Inspection: Location: 1503 78TH AVE 1.) Alt BM Description = 2.) Bldg sewer length = / ra,~k,✓T! - amount of cover ~t !r dye Plan revision Required? ❑ Yes No Use other side for additional information. Date Insepctor's Sig lure Cert. No. SBD-6710 (R.3/97) oa County r CEIV Safety and Buildings Division ® K ! 201 W. Washington Ave., P.O. Box 7162 !;a ary Permit Number (to e filled in by Co.) ~~D ~f`Madison, WI 53707-7162 aA` ! 4 1, 10MMUNITY Qgx it Aj,r State Translaction Number In accordance with SPS 383.21(2), Wis. Adm. Code, submission of this form to tit rT is required prior to obtaining a sanitary permit Note: Application forms for state-owned ru.. Project Address (if different than mailing address) the Department of Safety and Professional Servies. Personal information you rovide may be used rte. - urposes in accordance with the Privacy Law, s. 15.04(l m), Stats. L Application Information - Please Print All Information ` t Property Owner's Name arceI # ~l 01h - "Uri- S b 00o .17. ( d 1 Property Owner's Mailing Address } Property Location 0, 2.9 Govt Lot city, state Zip Code Phone Number ~I a Section 0 qtr ttu y p~ J~ T`~~ N; R E6rW, 11. Type of Budding (check all that apply) l n~ 2 Family Dwelling-Number of Bedrooms Subdivision Name 6k os ck # F t c2 ! ,i " ? Y its I' ❑ Public/Commercial - Describe Use ❑ City of ❑ State Owned - Describe Use CSM Number ❑,Village of Fl- of I.1.I. y : I wn s r= 12 X - A III. Type of Permit: (Check only one box on line A. Complete line B if applicable) d . ❑ tem Replacement System El TreatmentHolding Tank Replacement Only ❑ Othcr Modification to Existing System (explain) B. ❑ Permit Renewal ❑ Permit Revision ❑ Change of Plumber ❑ Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Owner IV. Type of POW, S stem/Com onent/Device: Check 1 that apply) ❑ Non-Pressurized In-Ground ❑ Pressurized In-Ground , t-Grade ❑ Mound 124 in. of suitable soil ❑ Mound < 24 in. of suitable soil i ❑ Holding Tank ❑ er Dispersal Component (explain ❑ Pr ent Device (explain) _ V. Dis rsal/Treat ent Area Information: S 9 evati y Design Flow (gpd) Design Soil Appli cation Rate.(gpdsf) Dispersal Area Required (sfl Disl~, Area Proposed f) ,2,eVii' ~°L C 7 l t VL Tank Info Capacity in Total # of Manufacturer 1 Gallons Gallons Units p o New Tanks Existing Tanks I \ o a v f~~ ~ r'1 rn rn v ~ Septic or Holding Tank 17 - r Dosing Chamber I z, IJ ~4l I ff 7, VII. Responsibility Statement the undersigned, ass a responsibility for installation of the POWTS shown on the attached plans. Plumber;s.Name (Print) Plumtb S' ature MP/MPRS Number Business Phone Numb !T( zol Plumber's Address (Street, City, S , Zip Code AeJ i VIII. untv/De artment Use Oniv -suing _ Si~mtature Approved ❑ D' ve Permit Fee Date sued T ~O • Zl'o 17 ❑ Given Reason for Denial DL Conditio t` easonj for Wfapproval 1. 5ept+.. aM(, Er tx'nr it te- t+ clisper.:ni cell . ust all be & tiicas ! rn= uliiLrg5; ~ ~~QM,~ • 1~OrX~ I' °AA {per,VW,3yement plan pro ltoe~ t,y pluinbe:. 2 ~0' 1001 46WIP c d~et+ df11ii1GL3. Attach to complete plans for the system and submit lithe County o y on paper aot~ than 8}z 11 inches > SBD-5398 (R 11/11) t JrQ` rte. 5) Olt. 17 , >-o ~er Cy ooh- ok- H"- /6'7,'V0 System PLOT PLAN PROJECT Rick Huard ADDRESS 200 Stockman St. Woodville Wi 54028 NW 1/4 NW 1/4S 30 /T 29 N/R 17 W TOWN Hammond COUNTY ST. CROIX SYSTEM ELEVATION 97.5' 3/31/17 BEDROOM 3 DATE CONVENTIONAL AT-GRADE XXX CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE DOSE TANK SIZE 630 HOLDING TANK SIZE LOAD RATE .5 ABSORPTION AREA 900 # of chambers none BENCHMARK V.R.P. Top of 2" pipe ASSUME ELEVATION 100' Filter Lifetime Filter ❑ BOREHOLE (DWELL *H.R.P. same as benchmark 78th Ave A, Scale = 1/4" = 10' 2 Acre Lot Pro 3 Bedroom House well is to meet all WDNR setbacks 200' Tank is to be properly bedded and provided with lockdown covers with approved warning labels Grading is to be done Huffcutt Combo Tank to divert run-off away from system 98' B-2 B.M.* 97.5 97 B-1 e 9 B -3 5% Slope Area 15' below system is to remain undisturbed \I Property Line ~~=ovr'R~'~1E~TO DIVISION OF INDUSTRY SERVICES 2331 SAN LUIS PL STE 150 l~ } GREEN BAY WI 54304-5211 I31 ` S P cI Contact Through Relay http://dsps.wi.gov/programs/industry-services www.wisconsin.gov Scott Walker, Governor Laura Guti6rrez, Secretary April 17, 2017 PR TOFSA. CUST ID No. 226900 ATTAI: POWTS Inspector r ROFFSSIONt SHAUN R BIRD ZONING OFFICE L' BIRD PLUMBING INC ST CROIX COUNTY SPIA 1432 120TH ST 1101 CARMICHAEL R l/ . NEW RICHMOND WI 54017-6409 HUDSON WI 54016-7708 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 04/17/2019 Identification Numbers Transaction ID No. 2928368 SITE: Site ID No. 837128 Rick Huard Please refer to both identification numbers, above, in all correspondence with the auency_ 1 1503 78TH Ave Town of Hammond St Croix County NW1/4, NW1/4, S30, T29N, R17W FOR: Description: At-Grade Q Bedrooms - New Construction) Object Type: POWTS Component Manual Regulated Object ID No.: 1701195 Maintenance required; 450 GPD Flow rate, 37 in Soil minimum depth to limiting factor from original grade; System(s): At-grade Component Manual, Version 2.0, SBD-10854-P (N.03/07, R. 1/12), Pressure Distribution Component Manual - Ver. 2.0, SBD-10706-P (N.01/01, R. 10/12); Effluent Filter The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. This system is to be constructed and located in accordance with the enclosed approved plans and with any component manual(s) referenced above. The owner, as defined in chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code requirements. No person may engage in or work at plumbing in the state unless licerlsed to do so by the Department per s. 145.06, stats. The following conditions shall be met during construction or installation and prior to occupancy or use: • Preserve dispersal area prior and during construction to avoid disturbance, compaction and use of the site. • With new construction; it is recommended not to activate the pump in the dose tank until the tanks are pumped prior to homeowner occupancy. • Wastewater generated from contractors cleaning of equipment and tools and/or left over construction products shall not be discharged into the drains discharging to the private onsite wastewater treatment system (POWTS). Waste generated shall be properly disposed of on-site or off site. • Any tall grasses, leaves and shrubs shall be cut short and removed prior to tilling the surface for installation to prevent matting under the dispersal area. All loose organic material to be removed from mound area. • Prior to construction of the dispersal area check the moisture content of the soil to a depth of 8 inches Smearing and compacting of wet soil will result in reducing the infiltration capacity of the soil Proper soil moisture content can be determined by rolling a soil sample between the hands If it rolls into a 1/4 inch wire the site is too wet to prepare If it crumbles site preparation can proceed If the site is too wet to prepare do not proceed until it dries. SHAUN R BIRD Page 2 4/17/2017 • Divert surface water from POWTS Area. • All piping shall conform to SPS Table 384.30-3 and SPS Table 384.30-5 • Insulate building sewer beyond 30 feet per SPS 382.30 (11)(c) • Tank Installation to follow all manufacture's recommendations. • Pump Floats to be set and verified per approved plan Any changes may result in pump resizing to meet TDH and GPM Specifications. • Verify property line(s) prior to installation. • Well setbacks to meet chs. NR 811 & 812. • Areas that are occupied with rock fragments, tree roots, stumps and boulders reduce the amount of soil available for proper treatment. If no other site is available, trees in the basal area of the at-grade must be cut off at ground level. A larger fill area is necessary when any of the above conditions are encountered, to provide sufficient infiltrative area. • SPS 383.54(1)(e) The management plan for a POWTS shall specifically address the servicing mechanics of an aerobic or anaerobic treatment tank or a holding tank where either of the following conditions exist: 1. The bottom of the tank is located more than 15 feet below the elevation where the servicing pad is located. 2. The bottom of the tank is located more than 150 feet horizontally from where the servicina_ pad is located.. Owner Responsibilities • The current owner, and each subsequent owner, shall receive a copy of this letter including instructions relating to proper use and maintenance of the system. Owners shall receive a copy of the appropriate operation and maintenance manual and/or owner's manual for the POWTS described in this approval SPS 383.54(1). • In the event this soil absorption system or any of its component parts malfunctions so as to create a health hazard, the property owner must follow the contingency plan as described in the approved plans. A copy of the approved plans, specifications and this letter shall be on-site during construction and open to inspection by authorized representatives of the Department, which may include local inspectors. All permits required by the state or the local municipality shall be obtained prior to commencement of construction/installation/operation. In granting this approval the Division of Industry Services reserves the right to require changes or additions should conditions arise making them necessary for code compliance. As per state stats 101.12(2), nothing in this review shall relieve the designer of the responsibility for designing a safe building, structure, or component. Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address on this letterhead. The above left addressee shall provide a copy of this letter and the POWTS management plan to the owner and any others who are responsible for the installation, operation or maintenance of the POWTS. Sincerely, Fee Required $ 250.00 This Amount Will Be Invoiced. When You Receive That Invoice, Please Include a Copy With Your Tim Vander Leest Payment Submittal. Private Sewage Plan Reviewer, Division of Industry Services WiSMART code: 7633 (920)492-2214, Monday - Friday 6 am To 3:30 pm tim.vanderleest@wisconsin.gov SHAUN R BIRD Page 2 4/17/2017 • Divert surface water from POWTS Area. • All piping shall conform to SPS Table 384.30-3 and SPS Table 384.30-5 • Insulate building sewer beyond 30 feet per SPS 382.30 (11)(c) • Tank Installation to follow all manufacture's recommendations. • Pump Floats to be set and verified per approved plan Anv chances may result in pump resizing to meet TDH and GPM Specifications. • Verify property line(s) prior to installation. • Well setbacks to meet chs. NR 811 & 812. • Areas that are occupied with rock fragments, tree roots, stumps and boulders reduce the amount of soil available for proper treatment. If no other site is available, trees in the basal area of the at-grade must be cut off at ground level. A larger fill area is necessary when any of the above conditions are encountered, to provide sufficient infiltrative area. • SPS 383.54(1)(e) The management plan for a POWTS shall specifically address the servicing mechanics of an aerobic or anaerobic treatment tank or a holding tank where either of the following conditions exist: 1. The bottom of the tank is located more than 15 feet below the elevation where the servicing pad is located. 2. The bottom of the tank is located more than 150 feet horizontally from where the servicing pad is located. Owner Responsibilities • The current owner, and each subsequent owner, shall receive a copy of this letter including instructions relating to proper use and maintenance of the system. Owners shall receive a copy of the appropriate operation and maintenance manual and/or owner's manual for the POWTS described in this approval SPS 383.54(1). • In the event this soil absorption system or any of its component parts malfunctions so as to create a health hazard, the property owner must follow the contingency plan as described in the approved plans. A copy of the approved plans, specifications and this letter shall be on-site during construction and open to inspection by authorized representatives of the Department, which may include local inspectors. All permits required by the state or the local municipality shall be obtained prior to commencement of construction/installation/operation. In granting this approval the Division of Industry Services reserves the right to require changes or additions should conditions arise making them necessary for code compliance. As per state stats 101.12(2), nothing in this review shall relieve the designer of the responsibility for designing a safe building, structure, or component. Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address on this letterhead. The above left addressee shall provide a copy of this letter and the POWTS management plan to the owner and any others who are responsible for the installation, operation or maintenance of the POWTS. Sincerely, Fee Required $ 250.00 This Amount Will Be Invoiced. When You Receive That Invoice, Please Include a Copy With Your Tim Vander Leest Payment Submittal. Private Sewage Plan Reviewer, Division of Industry Services WiSMART code: 7633 (920)492-2214, Monday - Friday 6 am To 3:30 pm tim.vanderleest@wisconsin.gov Cover Page ty Shaun Bird Bird Plumbing Inc. 'Y AND 'RO/iCES 1432 120th St. ;,135 New Richmond Wi 54017 715-246-4516 LE Date:3/31 /17 Owner:Rick Huard Location:NW 1/4 NW1/4 S30 T29 N,R17W 1503 78th ave Hammond Manuals Used: At-Grade Component Manual version 2.0 SBD 10854 (N. 03/07) Pressure Distribution Manual version 2.0 SBD 10706-P(N. 01/01 R. 10/12) Page# 1. Cover Page 2. At-Grade Plot Plan 3. At-Grade Cross Section 4. Pipe Cross Section/Pipe Layout 5. Pump Chamber Cross Section 6. Pump Curve 7-8. Maintance and Conti ency plan 9. Filter Specifications Attachments: Soil Test/, Shaun Bird ` 1 Signature License number 2 00 Page 1 of 9 i - J System PLOT PLAN PROJECT Rick Huard ADDRESS 200 Stockman St. Woodville Wi 54028 NW 1/4 NW 1/4S 30 /T 29 N/R 17 W TOWN Hammond COUNTY ST. CROIX SYSTEM ELEVATION 97.5' 3/31/17 BEDROOM 3 DATE CONVENTIONAL AT-GRADE XX)( CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE DOSE TANK SIZE 630 - HOLDING TANK SIZE LOAD RATE .5 ABSORPTION AREA 900 # of chambers none BENCHMARK V.R.P. 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Existing vegetation is mowed and raked off the site. The basal area (L x W) is staked out and plowed with a moldboard or chisel plow. Plowing may not proceed if the soil is wet enough at the plow depth to form a 1/4 inch soil wire when a sample is rolled between the palms of the hands.. The A x B area is covered by clean aggregate deposited overhead by a backhoe. Special care must be used when placing the aggregate to minimize compaction of the plowed surface. After-the topsoil cap is placed, the entire at-grade is seeded and mulched to promote vegetative gtq'*.ffi, limit erosion and protect from freezing. The observation pipes are perforated in the lower 6 inches. and secured in place. 03/05 1 91 Page of Pressure Lateral Layout One Lateral - End Manifold f- Threaded Cleanout Force Main Lateral Turn-up 0 Plug TT X L Long Sweep 90 Bend , J 1'J, Pressure System Construction Distribution Network S ecifications Lateral Diameter '2- In. Laterals are constructed of Schedule 40 PVC Orifice Diameter _6/ 3 In. pipe. Orifices are drilled perpendicular to X Orifice Spacing) In. the pipe with a sharp drill bit and face down. L Lateral Length) g ' Ft. Lateral turn-ups terminate with a threaded Force Main Diameter In. cleanout plug and are enclosed in a 6-8 inch Force Main Length Ft. diameter lawn sprinkler valve box accessible from finished grade. Grade •••••••_.p 6-8 Inch Lawn Sprinkler Valve Box 03/05lgj Page of Septic-Dose Wank Cross Section And Pump Performance Specifications Tank Manufacturer Pump Manufacturer Zo _ Tank Model Number 6 6 Pump Model Number 'S Total Tank Capacity '?J 3 D Alarm Manufacturer s Max. Bury Depth Alarm Model Number Switch Type Filter Manufacturer Total Dynamic Head (TDH) - Feet Filter Model Number Elevation Head Distal Pressure Network Loss A I Minimum Pump performance Required Force Main Loss 3 GPM' @ S; 3 Ft TDH Total IS • ,3 Outlet Manhole Min, V Above Grade With Manhole Min. 4" Above Grade Locking De~rice. Inlet Manhole With Locking Device < ti" Below Grade Sealed Watertight Securely Mounted Weather-proof 1 Finished Grade Junction Bo` s tt..... ttr Vent Min. 12" Disconnect Above Grade Means With Vent Cap 13 1.22 at {Jutlet Filter - Inlet inlet Baffle Switch Settings and Reserve Capacity A<T 1a" Tank Volume = GPI Weep Dimension: Inches Volume Gal. $ Hole (reserve) A; alarm B 2 ( ) ~ 0 Off Elevation C Ft (dose) C -7 '6. 0 (dead) D Bottom D Elevation Total y 6 3 C~ . > •'<i'-'T < >.rt>~ t < s><>ia~ < < [ a`. , . ><~,~<>a~.,'<#<~ >s~•,la < < . < < < <><. ;`.`.b`.'a<a',<.'a`.<. GENERAL INSTALLATION: The septic/dose tank is bedded and back filled in accordance with the manufacturer's product approval spowfications. Maximum depth of bury as specified by the manufacturer may not be exceeded without prior 4pproval. Manhole covers exposed to grade have an effective locking device (padlock) laid installed. Piping at the inlet and,oudet or is of approved material, connected to the tarok with watertight fittings, and on stable soil to prevent settling or sagging. The force main is sleeved with 4" Sch. 40 PVC to bridge the tank excavation and the sleeve is sealed watertight. Electri servi mplles with NEC 30t} and Comm 162K. 02/05 U Page of / TOTAL DYNAMIC HEAD/CAPACITY HEAD CAPACITY CURVE PER MINUTE EFFLUENT AND DEWATERING N MODEL 152/153 MODEL I 152 153 w t-- w 50 Feet I Meters GoL Liters I Col. Liters 153 5 1.5 i 69 261 77 291 12 40 10 I 3.1 61 231 1 70 265 152 15 4.6 53 I 201 61 231 i 20 .i 6.1 44 167 52 197 v 30 25 7.6 34 129 42 159 z 8 30 9.1 I 23 87 i 33 125 ° I 22 85 20 35 p i 40 12.2 11 42 4 i Lock Voive: X38.0 (11.5m)~44.0 Ft. (13.4m) 10 ` 0145M i r 0 0EIV 20 40 60 80 100 APR 0 3 2017 GALLONS LITERS 6 1/4 $ 5/8- 4 p 80 160 240 320 INS jU -I Y SER VW31&~ FLOW PER MINUTE I j 27/32 CONSULT FACTORY FOR SPECIAL APPLICATIONS • Timed dosing panels available. J ~/3z • Electrical alternators, for duplex systems, are available and supplied with 3 27 an alarm. • Variable level control switches are available for controlling single phase systems. • Double piggyback variable level float switches are available for variable level long and short cycle controls. I • Sealed Qwik-Box available for outdoor installations. See FM1420. • Over 130°F. (54°C.) special quotation required. I 1- 1521153 Series 12 1/8 1521153 MODELS Control Selection I IJII I I I Model Volts Ph Mode Am s Sim lex Du lex i 5 1/8 N752 115 1 Non 8.5 1 2or3 i BN152 115 1 Aura 8.5 Included 2or3 i sx2oe4 E152 7.30 1 Non 4.3 1 2 or 3 BE152 230 Auto 43 Indu ed 2 or 3 N153 115 1 Non 10.5 1 2 or 3 BN153 115 1 Aura 10.5 included 2or3 SELECTION GUIDE E153 230 . 1 Non 5.3 1 2 or 3 1. Single piggyback variable level float switch or double piggyback variable level float BE153 230 1 Auto 5.3 Inducted 2or3 switch. Refer to FM0477. A CAUTION 2. See FM0712 for correct model of Electrical Alternator E-Pak. Ali installation of controls, protection devices and wiring should be done by a qualified 3. Variable level control switch 10-0225 used as a control activator, specify duplex (3) licensed electrician. AR electrical and safety codes should be followed including the most Or (4) float system. recent National Electric Code (NEC) andthe Occupational Safety and Health Act (OSHA). RESERVE POWERED DESIGN For unusual conditions a reserve safety factor is engineered into the design of every Zoeller pump. MAIL TO: P.O. BOX 16347 Louisville, KY 40256-0347 Manutdctu ersof. . SNIP T0: 3649 Cane Run Road po ZD Louisville. KY 40211-1961 4J~Ty Pj~yrog 3,1647 ~~.7c! 4 y e (504 778-2731.1(600) 926-PUMP httPJ/wwwaae/ler-corn p/ael/W ICI FAX(502)774-3624 © Copyright 2000 Zoeller Co. All rights reserved. ©~(2 POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page of FILE INFORMATION SYSTEM SPECIFICATIONS Owner Z_L& Septic Tank Capacity al O NA Permit # Septic Tank Manufacturer ❑ NA 3ESIGN PARAMETERS Effluent Filter Manufacturer 0 NA Number of Bedrooms ❑ NA Effluent Filter Model ❑ NA .e~ i Number of Public Facility Units M &NA 'Pump Tank Capacity ~ ❑ NA al I Estimated flow (average} P R rS al/da Pump Tank Manufacturer 0 NA Design flow (peak), (Estimated x 1.5 ` l("N a Pump Manufacturer 0 NA Soil Application Rate aVda Jftz Pump Model ❑ NA i Standard Influent/Effluent Quality Monthly average" Pretreatment Unit A Fats, Oil & Grease (FOG) 530 mg/L ❑ Sand/Gravel Filter O Peat Filter Biochemical Oxygen Demand (BODs) 120 mg/L ❑ NA 0 Mechanical Aeration ❑ Wetland Total Suspended Solids (TSS) 5950 rn 0 Disinfection CI Other. Pretreated Effluent Quality Monthly average Dispersal Cell(s) ❑ NA Biochemical Oxygen Demand (BODs) 530 mg/L 0 in-Ground (gravity) 0 In-Ground (pressurized) Total Suspended Solids (TSS) 530 mg/L ,NA -Grade ❑ Mound Fecal Coliform (geometric mean) <_10a cfu/10om1 0 Drip-Line 0 Other: !Maximum Effluent Particle Size Ya in dia. ❑ NA Other 0 NA Other: NA Other: ❑ NA `Values typical for domestic wastewater and septic tank effluent Other 0 NA IAINTENANCE SCHEDULE Service Event Service Frequency linspect condition of tank(s) At least once every: 0 month(s) ears (Maximum 3 years) ❑ NA -3 A (Pump out contents of tank(s) When combined sludge and scum equals one-third (X) of tank volume 0 NA Inspect dispersal cell(s) At least once every' 0 month(s) -year(s) (Maximum 3 years) ❑ NA f--lean effluent filter At least once every: 0 onth(s) ❑ NA ear(s) Inspect pump, pump controls & alarm At least once every: 0 month(s) 0 NA S . Iff'year(s) f=lush laterals and pressure test At least once every: ❑ month(s) 0 NA ether. ;Myear(s) At least once every: El year(ts~s) NA ether. NA MAINTENANCE INSTRUCTIONS !Inspections of tanks and dispersal cells shall be made ~by an individual carrying one of the following licenses or certifications: Master (Plumber; Master Plumber Restricted Sewer; POWTS Inspector; POWTS Maintainer; Septage Servicing Operator. Tank inspections must linclude a visual inspection of the tank(s) to identify any missing or broken hardware, identify any cracks or leaks, measure the volume of ioombined sludge and scum and to check for any back up or ponding of effluent on the ground surface. The dispersal cell(s) shall be visually inspected to check the effluent levels in the observation pipes and to check for any ponding of effluent on the ground surface. The ponding of effluent on the ground surface may indicate a failing condition and requires the immediate notification of the local -egulatory authority. Iv/Vhen the combined accumulation of sludge and scum in any tank equals one-third or more of the tank volume, the entire contents of I:he tank shall be removed by a Septage Servicing Operator and disposed of in accordance with chapter NR 113, Wisconsin !administrative Code. !all other services, including but not limited to the servicing of effluent filters, mechanical or pressurized components, pretreatment units, And any servicing at intervals of 512 months, shall be performed by a certified POWTS Maintainer. A service report shall be provided to the local regulatory authority within 10 days of completion of any service event. Page of START UP AND OPERATION For new construction, prior to use of the POWTS check treatment tank(s) for the presence of painting products or other chemicals thit malt' impede the treatment process and/or damage the dispersal cell(s). If high concentrations are detected have the contents of the tank(s) removed by a septage servicing operator prior to use. System start up shall not occur when soil conditions are frozen at the infiltrative surface. During power outages pump tanks may fill above normal highwater levels. When power is restored the excess wastewater will ble discharged to the dispersal cell(s) in one large dose, overloading the cell(s) and may result in the backup or surface discharge of effluent. To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator prior to restoring power to the effluent pump or contact a Plumber or POWTS Maintainer to assist in manually operating the pump controls to restore normal levels within the pump tank. Do not drive or park vehicles over tanks and dispersal cells. Do not drive or park over, or otherwise disturb or compact, the area within 15 feet down slope of any mound or at-grade soil absorption area. Reduction or elimination of the following from the wastewater stream may improve the performance and prolong the life of the POWT$: antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floss; diapers; disinfectants; fat; foundations drain (sump pump) water; fruit and vegetable peelings; gasoline; grease; herbicides; meat scraps; medications; oil; painting producils; pesticides; sanitary napkins; tampons; and water softener brine. ABANDONMENT When the POWTS fails and/or is permanently taken out of service the following steps shall be taken to insure that the system is propeply and safely abandoned in compliance with chapter Comm 83.33, Wisconsin Administrative Code:. • All piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed. • The contents of all tanks and pits shall be removed and properly disposed of by a Septage Servicing Operator. • After pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space filled with soil, gravel or another inert solid material. CONTINGENCY PLAN If the POWTS fails and cannot be repaired the following measures have been, or must be taken, to provide a code compliOnt replacement system: ❑ A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption systelm. The replacement area should be protected from disturbance and compaction and should not be infringed upon by requirled setbacks from existing and proposed structure, lot lines and wells. Failure to protect the replacement area will result in the nded for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must comply with the rule;) in effect at that time. ❑ A suitable replacement area is not available due to setback and/or soil limitations. Barring advances in POWTS technology/ a holding tank may be installed as a last resort to replace the failed POWTS. The site has not been evaluated to identify a suitable replacement area. Upon failure of the POWTS a soil and site evaluation mtilst be performed to locate a suitable replacement area. If no replacement area is available a holding tank may be installed) as ~"last resort to replace the failed POWTS. )t4Mound and at-grade soil absorption systems may be reconstructed in place following removal of the biomat at the infiltrative ✓ surface. Reconstructions of such systems must comply with the rules in effect at that time. <<WARNING>> SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES AND/OR INSUFFICIENT OXYGEN. DO NOT ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE O~ A PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE. ADDITIONAL COMMENTS POWTS INSTALLER POWTS MAINTAINER Name Name Phone `'7 J Phone -'7~ ; J SEPTAGE SERVICING OPERATOR P PER LOCAL REGULATORY AUTHOR/ Name Name lX rau ! ) T Phone x-02 Phone 71s f -7 -1~a j I -L This document was dratted in compliance with chapter SPS 383.22(2)(b)(1)(d)&(f and 383.54(1), (2) & (3), Wisconsin Administrative Code. L') a I J]fi i :i i i t ~~It~n3 ~ I 4 CIO ;fy o P _j l Y 1 0 J - IJL- m i C) N h ~ O ~y C z o LU V y, o ~ D ~ i I U ST. CROIX COUNYY SEPTIC TANK MAINTENANCE t'kGREEMENT AND OWNERS CERTIFICATION FORM Owner/Buyer 1 ( c r Mailing Address Property Address -4 (Verification required from Planning & Zoning Department f w construction.) City/State Parcel Identification Number LEGAL DESCRIPTION Property Location AJ r/4 , '/a , Sec. T LN R 1W, Town ofl Subdivision Lot #6 Certified Survey Map # , Volume , Page # Warranty Deed # Volume , Page # Spec house yes no Lot line,, identifiable es / no SYSTEM MAINTENANCE AND OWNER CERTIFICATION Improper use and maintenance of your septic system could result in its pr=ature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, iY needed, by a licensed pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system Owner maintenance responsibilities are specified in §Comm 83.52(1) and in Chapter 12 - St Croix County Sanitary Ordinance. The property owner agrees to submit to St. Croix County Planning & Zoning Department a certification form, signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on-site wastewater disposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge. Vwe, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin, certification stating that your septic system has been maintained must be completed and returned to the St. Croix County Planning & Zoning Department within 30 days of the three year expiration date. I/we certify that all statements on this form are true to the best of mylour knowledge. I/we am/are the owner(s) of the property described above, by virtue of a warranty deed recorded in Register of Deeds Office. Number of 0 1P~Lic SIGNATURE (S) DATE ***Any information that is misrepresented may result in the sanitary permit being revoked by the Planning & Zoning Department Include with this application a recorded warranty deed from the Register of Deeds Office and a copy of the certified survey map if reference is made in the warranty deed. 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I ill I I ll III II III Z l 0 I m'I1 II w w w~= !I I ' W 0 <E Ea l o Fs - E 4 CST -,~G> Ll 1 RECEIV _ i- APR 1 0 201 Wisconsin Department of Commerce SOIL EVALUN t Page of Division of Safety and Builotg CROCK COUNTY ;OMMUNffY pEMEWB with Comm 85, Wis. Adm. Code County Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must include, but not limited to: vertical and horizontal reference point (BM), direction and parcel LD; ~7 n percent slope, scale or dimensions, north arrow, and location and distance to nearest road. i f Please print all information. Revie by Date personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). 1 Property Owner Property Location - k/ ` Govt. Lot~~ 1/4 t/ A S 7 T N R r E (o W . Name cow Property Owner's Mailing Address Lot # Block # Irlo-If ~07J ` Yw ✓ C City State Zip Code Phone Number ❑ City Village To Nearest R d f / " Eg New Construction User Residential / Number of bedrooms 3 Code derived design flow rate GPD ❑ Replacement ❑ Public or commercial - Describe: Parent material ic~ Flood Plain elevation if applicable !/t✓ ft. General continents and recommendations: ZQ►r..t~ System Elevation System Type i Boring # ❑ Boring `11 ®pit Ground surface elev. ft. Depth to limiting factor S in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 •Eff#2 : C G ~y / r><nn x < "I" / - ✓fn - ~ ~ 0 10 ' ' ea Y7 Boring # ❑ Boring _ 3 pit Ground surface elev. 1 ft. Depth to limiting factor 3 / in. 9 Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff in. /M}}unsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 •Eff#2 57- 7u " S Effluent #1 = BOD. > 30 < 220 mg/L and TSS >30 < 150 ' Effluent #2 = BOD, < 30 mg/L and TSS < 30 nWL CST Name (Please Print) yxe---~ CST Number Bird Plumbing, Inc. Shaun Bird / 226900 Address ...Date Evaluation Conducted Telephone Number 1432 120th St, New Richmond, WI 54017 j j " 715-246-4516 Property Owner _ Parcel ID # / Page of Z A Boring # ❑ Boring d/ Pit Ground surface elev. + ft. Depth to limiting factor- in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Effff#2 Fs~~~ i ° r~%~ ' y ❑ Boring # ❑ Boring ❑ pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 E] Boring F-1 Boring # Ground surface elev. ft. Depth to limiting factor in. ❑ Pit Soil Application Rate Horizon ')epth Dominant Color Redox Description. Texture Structure Consistence Boundary Roots GPD/ff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 Effluent #1 = BODS > 30 < 220 mg/L and TSS >30 < 150 mg/L ' Effluent #2 = BODS < 30 mg/L and TSS < 30 mg/L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608-266-3151 or TTY 608-264-8777. SBD-8330 (8.6/00) Property Owner Parcel ID # Page of Boring #Boring Pit Ground surface elev. to t R Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Stricture Consistence Boundary Roots GPDM in. Munseli Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 ❑ Boring # ❑ Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Sal -Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDRFt " in. Munseli Qu. Sz Cont. Colo Gr. Sz. Sh. 'Eff#1 'Eft#2 ❑ Boring Boring # F-1 ❑ Pit Ground surface elev. R Depth to limiting factor in. Rate Soft Appization Horizon -*Ah Dominant Color Redox Description- Texture Structure Consistence. Boundary Roots GPD/ff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 ' Effluent #1 = BOD, > 30 < 220 mglL and TSS >30 1150 mglL ' Effluent #2 = BOOS 130 mgA- and TSS < 30 mg/L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608-266-3151 or TTY 608-2648777. SBD4310OL6W> Soil Test Plot Plan r, Project Name Rick Huard Shaun d / Address 200 Stockman St. ! t Woodville Wi 54028 C "M #226900 Lot 86 Subdivision Emerald Acres 1st. Add Date 3/31/17 N W 1/4 N W 1/4S 30 T 29 N/R17 W Township Hammond ❑ Boring 0 Well PL Property Line County ST. CROIX BM or VRP Assume Elevation 100 ft. Top of 2" pipe System Elevation 97.5' *HRPSame as Benchmark 78th Ave Scale = 1/4" = 10' 2 Acre Lot 200' B-2 5% Slope 98' ❑ B.M.* 97' ❑ B-1 96' B-3 Property Line